WHO Statement on Caesarean Section Rates

World Health OrganizationWHO, UNDP, UNFPA,World Bank Special Programme Res, UNICEF,Dev & Res Training Human Reprod,Dept Repro, CH-1211 Geneva, SwitzerlandUniv Fed Sao Paulo, Sao Paulo Sch Med, Brazilian Cochrane Ctr, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo Sch Med, Dept Obstet, Sao Paulo, BrazilShanghai Jiao Tong Univ, Sch Med, Shanghai Key Lab Childrens Environm Hlth, Minist Educ,Xinhua Hosp, Shanghai 200030, Peoples R ChinaUniv Fed Sao Paulo, Sao Paulo Sch Med, Brazilian Cochrane Ctr, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo Sch Med, Dept Obstet, Sao Paulo, BrazilWHO: 001Web of Scienc

WHO Statement on Caesarean Section Rates

World Health OrganizationWHO, UNDP, UNFPA,World Bank Special Programme Res, UNICEF,Dev & Res Training Human Reprod,Dept Repro, CH-1211 Geneva, SwitzerlandUniv Fed Sao Paulo, Sao Paulo Sch Med, Brazilian Cochrane Ctr, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo Sch Med, Dept Obstet, Sao Paulo, BrazilShanghai Jiao Tong Univ, Sch Med, Shanghai Key Lab Childrens Environm Hlth, Minist Educ,Xinhua Hosp, Shanghai 200030, Peoples R ChinaUniv Fed Sao Paulo, Sao Paulo Sch Med, Brazilian Cochrane Ctr, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo Sch Med, Dept Obstet, Sao Paulo, BrazilWHO: 001Web of Scienc

Tryptophan and methionine levels in quality protein maize breeding germplasm

Because maize (Lea mays L.) is often used either as food for humans or as feed for monogastric animals, essential amino acid levels are important. Maize kernels containing the opaque-2 (o2) mutation have improved amino acid balance and poor agronomic qualities including opaque kernels that are soft and susceptible to mechanical and biological damage. Quality Protein Maize (QPM) developed through plant breeding has improved amino acid balance conferred by the opaque-2 (o2) mutation, but lacks the agronomic deficiencies normally associated with this mutation. To characterize the amino acid balance in QPM breeding germplasm, we determined the levels of nutritionally limiting amino acids tryptophan and methionine. Tryptophan levels were negatively correlated with endosperm translucence, a measure of kernel hardness suggesting the process of selection for hard-kernels reduces tryptophan levels. On average, germplasm containing the o2/ o2 mutation had lower methionine levels than 02/ 02 germ plasm regardless of kernel hardness, suggesting methionine levels could be reduced by the o2/ o2 mutation. A series of inbred lines was test-crossed to the o2/o2 soft endosperm inbred line Tx804. The predictive value of the characteristics of the inbred line for the characteristics of the hybrids was examined. The amino acid levels of the inbred lines were significantly correlated with those of the hybrids, although the predictive value was low (1{2 = 0.13 and 0.27 for methionine and t1yptophan, respectively). The reduction in tryptophan during conversion to the hard-kernel phenotype and the reduction in methionine in o2 germplasm both reduce the nutritional value of QPM. It may be possible to correct these deficiencies by breeding and selection for levels of tryptophan and methionine.This article is published as Scott, M. P., Sandeep Bhatnagar, and Javier Betran. "Tryptophan and methionine levels in quality protein maize breeding germplasm." Maydica 49 (2004): 303-311.</p

Puesta a punto de la metodología de ejercicios de intercomparación para análisis de fertilidad de suelos. Primeros resultados

Este trabajo recoge la metodología de realización de un ejercicio de intercomparación entre laboratorios españoles que ofertan análisis de la fertilidad de los suelos. Se prepararon alícuotas de cada una de las dos muestras de gran volumen, tomadas en dos suelos con marcadas diferencias entre sí. Una vez testada la homogeneidad de alícuotas se envió una de cada suelo a cada uno de los veintiún laboratorios participantes, junto con instrucciones y un formato para remisión de resultados. En todo el proceso se veló especialmente por la confidencialidad de los resultados de cada participante. Recibidas las respuestas se procedió al análisis de resultados, asignación de valores de consenso y evaluación de cada resultado mediante el indicador “z-score”. El ejercicio ha sido muy bien recibido en un colectivo de laboratorios que no mantenía apenas contacto, y se ha mostrado muy eficaz en la caracterización de la calidad de los resultados emitidos. Se ha puesto en evidencia que hay parámetros con resultados muy homogéneos (pH) frente a otros con diferencias incompatibles con el uso agronómico fiable de los análisis (granulometría, fósforo asimilable, etc.). Queda de manifiesto la urgente necesidad de mantener periódicamente este tipo de ejercicio, como un control de calidad externo que aumente la fiabilidad de los laboratorios. This work includes the methodology for carrying out a proficiency testing program between Spanish laboratories that offer soil fertility analysis. Aliquots of each of the two large volume samples were prepared, taken from two surface horizons of soils with marked differences between them. Once the homogeneity of aliquots was tested, one sample of each soil was sent to each of the twenty-one participating laboratories, together with the instructions and a format for the submission of results. Throughout the process, special care was taken to ensure the confidentiality of the results of each individual participant. Once the responses were received, the results were analyzed, consensus values were assigned and each result was evaluated using the "z-score" indicator. The exercise was very well received by the participating laboratories, and has been very effective in characterizing the quality of the results issued. It has been shown that there are parameters with very homogeneous results (pH) compared to others with differences incompatible with the reliable agronomic use of analyses (granulometry, assimilable phosphorus, etc.). The urgent need to maintain this type of intercomparison exercise periodically, as an external quality control that increases the reliability of laboratories, is evident

A global reference for caesarean section rates (C‐Model): a multicountry cross‐sectional study

Objective: To generate a global reference for caesarean section (CS) rates at health facilities. Design Cross-sectional study. Setting: Health facilities from 43 countries. Population/Sample Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing. Methods: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Main outcome measures: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. Results: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/ reproductivehealth/publications/maternal_perinatal_health/c-model/en/). Conclusions: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. Tweetable abstract: The C-Model provides a customized benchmark for caesarean section rates in health facilities and system

Making stillbirths count, making numbers talk - issues in data collection for stillbirths.

BACKGROUND: Stillbirths need to count. They constitute the majority of the world's perinatal deaths and yet, they are largely invisible. Simply counting stillbirths is only the first step in analysis and prevention. From a public health perspective, there is a need for information on timing and circumstances of death, associated conditions and underlying causes, and availability and quality of care. This information will guide efforts to prevent stillbirths and improve quality of care. DISCUSSION: In this report, we assess how different definitions and limits in registration affect data capture, and we discuss the specific challenges of stillbirth registration, with emphasis on implementation. We identify what data need to be captured, we suggest a dataset to cover core needs in registration and analysis of the different categories of stillbirths with causes and quality indicators, and we illustrate the experience in stillbirth registration from different cultural settings. Finally, we point out gaps that need attention in the International Classification of Diseases and review the qualities of alternative systems that have been tested in low- and middle-income settings. SUMMARY: Obtaining high-quality data will require consistent definitions for stillbirths, systematic population-based registration, better tools for surveys and verbal autopsies, capacity building and training in procedures to identify causes of death, locally adapted quality indicators, improved classification systems, and effective registration and reporting systems

WHO Statement on Caesarean Section Rates

In 1985 when a group of experts convened by the World Health Organization in Fortaleza, Brazil, met to discuss the appropriate technology for birth, they echoed what at that moment was considered an unjustified and remarkable increase of caesarean section (CS) rates worldwide.1 Based on the evidence available at that time, the experts in Fortaleza concluded: ‘there is no justification for any region to have a caesarean section rate higher than 10–15%’.1 Over the years, this quote has become ubiquitous in scientific literature, being interpreted as the ideal CS rate. Although this reference range was intended for ‘populations’, which are defined by geopolitical boundaries, in many instances it has been mistakenly used as the measurement for healthcare facilities regardless of their complexity or other characteristics. In addition to the case mix of the obstetric population served, the use of CS at healthcare facilities is also affected by factors such as their capacity to handle cases, availability of resource and the clinical management protocols used locally

The Midwives Service Scheme in Nigeria

Seye Abimbola and colleagues describe and evaluate their programme in Nigeria of recruiting midwives to rural areas to provide skilled attendance at birth, which is much poorer than in urban areas

Maternal clinical predictors of preterm birth in twin pregnancies: A systematic review involving 2,930,958 twin pregnancies

Supplementary material related to this article can be found, in the online version, at doi:https://doi.org/10.1016/j. ejogrb.2018.09.025